Interview with Prof Manoj Karmakar – Carl Koller Winner 2023

ESRA awards the Carl Koller Award annually to individuals in recognition of outstanding lifetime contributions to the field of Regional Anaesthesia and/or Pain Medicine. The 2023 recipient was Professor Manoj Karmakar from the Department of Anaesthesia and Intensive Care of the Chinese University of Hong Kong. Professor Karmakar is internationally recognized for his research in regional anaesthesia in adults and children, and his areas of research interest include thoracic paravertebral block, spinal sonography, ultrasound-guided central neuraxial blocks and local anaesthetic pharmacology. He has pioneered many novel regional anaesthetic techniques and published extensively. His research work has been cited 8680 times (Google Scholar as of 19/12/23), and his H-index is 48. Professor Karmakar recently spoke about his career to Nuala Lucas, ESRA Updates editor.

Nuala: Congratulations on winning the ESRA’s Carl Koller Award in 2023. Can you tell us what this recognition means to you and your career in Regional Anaesthesia and Pain Medicine?

Prof Karmakar: I perceive it as at the top of my career achievements, particularly because, as clinicians, we never really work for rewards. When you do your work or research, being recognized and nominated for an award is incredible. I’m honoured and humbled to accept it, particularly being the first Asian doctor to receive the Carl Koller Award. This means a lot to me – I think it’s great recognition because a lot of good work has happened in Asia. I’m sure the future holds great things for Asia and Asian anaesthesiologists. To be the first Asian doctor to receive the award also speaks volumes about ESRA for their openness and the recognition that they have offered. The list of recipients of the Carl Koller Award is so distinguished – a list of who’s in who in regional anaesthesia. So it’s a very proud moment for me, but I feel humbled when I see the names on the list.

Nuala: That’s such a nice answer – recognizing our colleagues worldwide working hard to promote good and regional anaesthesia care. You don’t need to be humble, Manoj; no one deserves to be on that list more than you. Could you share a couple of highlights from your career? I’m sure there’s been many!

Professor Manoj Karmakar receiving the Carl Koller Award at the 6th World Congress on Regional Anaesthesia & Pain Medicine (Paris, September 2023).

Prof Karmakar: It’s tough to pinpoint a specific highlight in the career, but I think of late, my work, particularly in the field of spinal sonography, has really been a game changer. We trained in the period when we did everything with touch and feel as landmarks. Spinal sonoanatomy has definitely made a world of difference. My contribution to helping unravel the mysteries of the sonoanatomy of the spine has been remarkable. I can share a moment from that experience; I’d been trying to unravel this for many years before it really happened. It so happened one evening when I was watching television. It suddenly came to my mind that Manfred Greer, you know, Manfred is from Austria. They had put a cervical spine in a water bath, and they had scanned it for their medial branch block study. So it dawned on me that, why don’t I just put this old model into the water and scan it, and then I’d be able to define the anatomy. And from there, we’re going to take it on. So I think it was about 11 p.m. at night, and my fellow at the time said, ‘‘Come on, Michael, wake up because it’s time to go and do some work.’’ He said, ‘’Where are we going?’’ I said, ‘’We’re going to the laboratory to go out and do some work.’’ So that really, I believe, was a turning point in my career because from then on, I think we were able to define not only the anatomy but also the musculoskeletal anatomy of the spine. And then, we went on to do real-time epidurals and spinals. And I think the future holds very bright because today, although it is used mostly for, as you know, pre-scanning, I believe the improvement in technology and, more importantly, the improvement in individual skills, particularly dexterity, will see ultrasound become an integral part central nerve blocks as we do for peripheral nerve blocks. So, I would say that’s probably the highlight of my recent anaesthesia career today.

Nuala Lucas: That’s such a wise answer, Manoj! What initially sparked your interest in regional anaesthesia and pain medicine? Why did you decide to pursue a career in this area? Was it by chance or something else?

Prof Karmakar: You know, you may be aware that I come from India, and I did my early training in anaesthesia in India at a prestigious institute in Pondicherry called the Jawaharlal Institute of Postgraduate Medical Education and Research. While I was doing my training, my professor at the time was Professor PR Kangle, MD. She was, to me, a role model. She did things most people would never even venture to do because she was a specialist in pain medicine. As you can imagine, in the early nineties, there were very few people, not only in India but all across the world, who were doing regional anaesthesia interventions for pain. So I always followed her and saw her doing these things. Obviously, I was training for my basic anaesthesiology, but that was the first kind of introduction that I should think fully about what I should do differently. And when the time is right, I mean to do this part of my repertoire and take regional anaesthesia as one of my career goals. That really initially sparked my interest. It was when I went to the UK and did my fellowship at the Royal College after a short stint in New Zealand.

Stay tuned for the full interview and Prof Karmakar’s insights and wisdom. Soon available.